Understanding the Braden Scale in Long-Term Care: Part 1 of a 6 Part Analysis

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neuropathy testing for sensory perception (Braden Scale)

By Holly Hovan MSN, APRN, CWOCN-AP

Part 1 of a series analyzing the use of the Braden Scale for Predicting Pressure Sore Risk® in the long-term care setting.

As wound care professionals, the Braden Scale is near and dear to our hearts. With that in mind, our evidence-based tool needs to be used correctly in order to yield accurate results. Working with long-term care and geriatric populations opens up a world of multiple pre-existing comorbidities and risk factors that aren’t always explicitly written into the Braden Scale categories. Additionally, the frequency of the Braden Scale may also contribute to a multitude of different scores; the resident behaves differently on different shifts, for example, asleep on night shift but up and about on days. What is the correct way to score them? I believe that a less frequent Braden Scale assessment yields more accurate results. However, we should still complete a Braden Scale on admission, transfer, receiving, and most importantly, with any change in condition.

What is the Braden Scale?

Briefly put, the Braden Scale is an evidenced-based tool, developed by Nancy Braden and Barbara Bergstrom, that predicts the risk for developing a hospital or facility acquired pressure ulcer/injury. The Braden Scale uses a scores from less than or equal to 9 to as high as 23. The lower the number, the higher the risk for developing an acquired ulcer/injury.

19-23 = no risk
15-18 = mild risk
13-14 = moderate risk
less than 9 = severe risk

There are six categories within the Braden Scale: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.

In this blog, I will be addressing sensory perception as defined by the Braden Scale, and how this is applicable to residents of a long-term care facility.

Braden Scale Scoring for Sensory Perception

Sensory perception: the ability to respond meaningfully to pressure-related discomfort.

The resident is scored on a scale of 1-4 in the categories below:

1: Completely limited
2: Very limited
3: Slightly limited
4: No impairment

Please review the Braden Scale card for a deeper definition of each of these terms. With regard to sensory perception, I want to stress the importance of assessing neuropathy in residents with diabetes, recognizing paralysis/loss of sensation with spinal cord injury (SCI) residents, and understanding how sensory perception may vary in the dementia population.

These three populations are often seen in long-term care facilities, so it’s important to understand their unique situations. Most people recognize SCI as a loss of sensory perception, but diabetic neuropathy is sometimes missed. A simple monofilament test may be used to check for sensation/neuropathy in residents with diabetes. In addition, vascular status should be assessed, including pulses on the lower extremities and capillary refill.

After assessing for neuropathy and possibly vascular issues, the definitions of the Braden Scale for each of the subcategories (1-4) should be read and understood, and an appropriate number assigned to the subcategory. A resident with paraplegia experiencing loss of sensation to the lower half of the body would automatically only score a 2 due to loss of sensation over half of the body. A resident with diabetes with some neuropathy in the feet would automatically score a 3 if they cannot feel pain or discomfort in one or more of their extremities.

The subcategory “no impairment” is very rarely accurate with the long-term care population. These residents are in the hospital, scooting up in bed, spending more time in bed, possibly wheelchair bound, have multiple pre-existing comorbidities, and usually one or more deficits. It is possible to score a 4 here, but again, rare.

The take away point here for sensory perception is to assess for neuropathy, SCI, and dementia. These residents may often be deficient in this specific category. It is important to understand the category and definitions in order to accurately score the resident. Education with nursing staff is pertinent here, and pocket cards are always helpful. Yearly competencies for long-term care staff on Braden Scale education are also helpful, along with orientation for new nurses, to be sure that the information is understood. Education by a certified wound, ostomy and continence nurse, continued support, and follow-up are needed to ensure accurate Braden Scale scores within any facility.

Up next: The Braden Scale subcategory MOISTURE.

Note: For anyone who wishes to utilize the Braden Scale in their health care facility, you must request permission to do so. Please visit www.bradenscale.com and complete the Permission Request form.

About the Author
Holly Hovan is a WOC nurse at the Cleveland Veterans Affairs Medical Center in long-term care/geriatrics. She has been practicing as a WOC nurse since 2013. Ms. Hovan has a passion for education, our veteran population, and empowering others to learn and succeed.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Comments

DON of long term care facility for residents with developmental disabilities

I like the Braden Scale

Excellent article

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